Dynamic Changes and Nomogram Prediction for Sinistral Portal Hypertension in Moderate and Severe Acute Pancreatitis

Frontiers in Medicine

article

Chen Yu¹  Ling Ding¹  Meilan Jiang³  Qian Liao²  Xin Huang¹  Yupeng Lei¹  Huajing Ke¹  Huifang Xiong¹  Wenhua He¹  Liang Xia¹  Xianjun Zeng²  Nonghua Lu¹  Yin Zhu¹ 

[1] Department of Gastroenterology, The First Affiliated Hospital of Nanchang University;Jiangxi Province Medical Imaging Research Institute;Gaoxin Hospital of the First Affiliated Hospital of Nanchang University;Department of Radiology, The First Affiliated Hospital of Nanchang University

关键词: acute pancreatitis;    sinistral portal hypertension;    nomogram;    severe acute pancreatitis;    prediction;   

DOI  :  10.3389/fmed.2022.875263

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Objectives To investigate the dynamic changes in gastric varices in patients with acute pancreatitis (AP) and to develop a novel nomogram for the early prediction of sinistral portal hypertension (SPH). Methods This was a retrospective, case-control study with an analysis of the quantitative, dynamic computed tomography imaging results of SPH in patients with moderate and severe AP with a long-term follow-up. Multivariate logistic regression analysis and nomogram were employed. Results The SPH group ( n = 94) and non-SPH group ( n = 94) were matched. The dynamic changes showed an increasing trend in the diameter of gastric fundus, short gastric, gastric coronary, and gastroepiploic veins, which did not recover during the one-year follow-up. Multivariate analysis showed that male (adjusted odds ratio (adjOR), 8.71; 95% confidence interval (CI), 2.86–26.53; P < 0.001), body mass index ≥27.5 kg/m 2 (adjOR, 5.49; 95% CI, 1.85–16.29; P = 0.002), prothrombin time ≥12.6 s (adjOR, 2.82; 95% CI, 1.11–7.17; P = 0.03), and the patency of splenic vein [stenosis (adjOR, 8.48; 95% CI, 2.13–33.71; P = 0.002), and occlusion (adjOR, 34.57; 95% CI, 10.87–110.00; P < 0.001)] were independently associated with the development of SPH. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.92 (95% CI, 0.87–0.95). Conclusion The dynamic changes in varices in SPH are long-term and slowly progressing. Males and obese patients with abnormal splenic veins and coagulopathies are at high risk for developing SPH. A simple nomogram tool helps in the early, accurate prediction of SPH.

【 授权许可】

CC BY